<%@ page language="java" contentType="text/html; charset=UTF-8" isELIgnored="false" pageEncoding="UTF-8" %>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core" %>
<%@ taglib prefix="fn" uri="http://java.sun.com/jsp/jstl/functions" %>
<%@ taglib prefix="fmt" uri="http://java.sun.com/jsp/jstl/fmt" %>
<!DOCTYPE html>
<html>
<head>
    <meta charset="UTF-8">
    <title>LarryBlogCMS-Home</title>
    <link rel="stylesheet" type="text/css" href="${pageContext.request.contextPath}/common/layui/css/layui.css"
          media="all">
    <link rel="stylesheet" type="text/css" href="${pageContext.request.contextPath}/common/bootstrap/css/bootstrap.css"
          media="all">
    <link rel="stylesheet" type="text/css" href="${pageContext.request.contextPath}/common/global.css">
    <link rel="stylesheet" type="text/css" href="${pageContext.request.contextPath}/css/main.css" media="all">
    <script type="text/javascript"
            src="${pageContext.request.contextPath}/common/bootstrap/js/jquery-1.12.4.js"></script>
    <script type="text/javascript"
            src="${pageContext.request.contextPath}/common/bootstrap/js/bootstrap.min.js"></script>
</head>
<body>
<html>
<div class="panel-body">
    <form  id="dempentform" method="post" action="">
        <div class="col-xs-12">
            <div class="form-group col-sm-2 text-left">
                <label>住院号</label>
                <input type="text" class="form-control" placeholder="" name="username" value="">
            </div>
            <div class="form-group col-sm-2 text-left">
                <label>门诊号</label>
                <input type="text" class="form-control" placeholder="" name="username" value="">
            </div>
            <div class="form-group col-sm-2 text-left">
                <label>姓名</label>
                <input type="text" class="form-control" placeholder="" name="username" value="">
            </div>
            <div class="form-group col-sm-2 text-left">
                <label>出生日期</label>
                <input type="date" class="form-control" placeholder="" name="username" value="">
            </div>
        </div>
    </form>
</div>
</html>